Budi D Machsoos, Shinta O Wardhani, , Djoko H Hermanto

Lung cancer is the most commonly diagnosed cancer and the leading cause ofcancer death worldwide. Lung cancer accounted for 13% (1,6 million) of the totalcancer cases and 18% (1,4 million) of the cancer deaths in 2008.1 There is a largevariation of the incidence and mortality rate of lung cancer in the word especially inAsia. Smoking is the leading cause of lung cancer, and other risk factors such asindoor coal burning, cooking fumes, and infections may play important roles in thedevelopment of lung cancer among Asian never smoking women. The median age ofdiagnosis in Asian patients with lung cancer is generally younger than Caucasianpatients, particularly among never smokers.1

Incidence and mortality attributed to lung cancer has risen steadily sincethe 1930s. Efforts to improve outcomes have not only led to a greaterunderstanding of the etiology of lung cancer, but also the histologic andmolecular characteristics of individual lung tumors. This article describes thisevolution by discussing the extent of the current lung cancer epidemicincluding contemporary incidence and mortality trends, the risk factors fordevelopment of lung cancer, and details of promising molecular targets fortreatment.5

Recent epidemiologic studies and clinical trials have shown consistently thatAsian ethnicity is a favorable prognostic factor for overall survival in non-small celllung cancer (NSCLC), independent of smoking status. Compared with Caucasianpatients with NSCLC, East Asian patients have a much higher prevalence ofepidermal growth factor receptor (EGFR) mutation (approximately 30% vs. 7%,predominantly among patients with adenocarcinoma and neversmokers), a lowerprevalence of K Ras mutation (less than 10% vs. 18%, predominantly amongpatients with adenocarcinoma and smokers), and higher proportion of patients whoare responsive to EGFR tyrosine kinase inhibitors . The ethnic differences inepidemiology and clinical behaviors should be taken into account when conductingglobal clinical trials that include different ethnic populations .2,3

The awareness of early signs and symptom of lung cancer in order to get themdiagnosed and treated at early stage and diagnosis of lung cancer is a key to detect itearly. As symptoms of early lung cancer are easily confused with many diseases,which is also an important factor resulting in patients delay of treatment. Chest X-ray: this is commonly first lung cancer imaging test CT scanning: a CT scan of thechest may be ordered when X-rays do not show an abnormality or do not yieldsufficient information about the extent or location of a tumor. MRI performed if weneed better show the extent of tumors and involvement of blood vessels. However,CT scanning is highly recommended for pulmonary solid lesions.PET scans:differentiated from traditional imaging techniques, PET scans measure metabolicactivity and the function of tissues. It can determine whether a tumor tissue is activelygrowing and can aid in determining the type of cells within a particulartumor.Pathology examination: diagnosis of lung cancer mainly depends on theexaminations of tissue, cytology, and clinically many auxiliary examinations are usedfor collecting specimens of lung cancer. Cytological specimens mainly come fromsputum, serous cavity effusion, brush biopsy by fiberoptic bronchoscopy and variousregions of specimens by fine needle aspiration.

Keynote : Epidemiology, Diagnosis, Lung Cancer, Asia

Lung cancer is the most commonly diagnosed cancer and the leading cause ofcancer death worldwide. Lung cancer accounted for 13% (1,6 million) of the totalcancer cases and 18%(1,4 million) of the cancer deaths in 2008.1 There is a largevariation of the incidence and mortality rate of lung cancer in the word especially inAsia. In males, the highest lung cancer incidence rates are different between Europe(Age-standardized rate,ASR of 57 and 49 per 100.000 respectively), North America(ASR of 48,5 per 100.000) and Eastern Asia(ASR of 45 per 100.000).1 In females, thehighest lung cancer incidence found in North America (ASR of 35,8 per 100.000)Northern Europe (ASR of 21,8 per 100.000) and Eastern Asia (ASR of 19,9 per100.000). The different incidence between male and female explains that in the USapproximately 45% of patients with NSCLC are women, however in Eastern Asia,only 25% to 30% of patients with lung cancer are women.1 There are other differences in characteristics of lung cancer patients betweenAsia and the US. Asian patients have generally a younger age of onset. In addition,the median age of Asia never-smoker patients (defined as never smoked or smokedless than 100 cigarettes in the lifetime) is significantly younger than ever-smokerpatients.1 In Asia, more than 30%of patients with lung cancer are never-smokers andhalf or more lung cancer in women occur in never-smokers. In China the mortality oflung cancer has doubled between the 1970s and 1990s. Despite the lower prevalenceof smoking, Chinese females have a higher prevalence of lung cancer (21,3 cases per100.000 females) than do females in certain European countries.1 Other known risk factors for lung cancer include second hand smoking, dietand food supplements, Alcohol drinking, exercise and physical activity, air pollution(indoor air pollution mainly due to coal burning, account for 13% of lung cancer inmale and 17% of lung cancer in female in China) and occupational/environmentalexposure. Infections such as tuberculosis and human papillomavirus may contribute tothe development of lung cancer among Asia women.1 Family history and genetic susceptibility play important roles in thedevelopment of lung cancer.